Notice ID: HT940224R0002
Related Notice: HT940221R0002
The objectives of this contract are to support the missions of the MHS which enable the National Defense Strategy by providing a Medically Ready Force, a Ready Medical Force, and improving the health of all those entrusted to its care. The objectives below represent the performance outcomes for this contract and are supported by technical requirements.
Objective 1, Compliance Reviews. Provide independent, impartial reviews (manual readjudication) of claims, to include timely and accurate evaluations of each purchased care contractor’s healthcare claims processing and payment record coding procedures.
Objective 2, Focused Studies. Assist the Improper Payment Evaluation Branch (IPEB) in studying areas of the TRICARE health benefits program with the potential for incurring a higher than average risk of improper payments, including claims selected for an annual Payment Integrity Information Act of 2019 (PIIA) compliance review.
Objective 3, Medical Record Reviews. Validate that healthcare services documented in a patient’s medical record is correctly invoiced to the Government for payment.
Objective 4, Continuity of Review Services. Maintain effective management solutions to provide the necessary claims review services, incorporating DHA and healthcare standards and best practices.
The purpose of this contract is to assist the Office of the Assistant Secretary of Defense for Health Affairs (OASD-HA), the Office of Management and Budget (OMB), and the DHA Improper Payment Evaluation Branch (IPEB), in identifying and reporting improper payments and discrepancies in payment record coding. This contract provides an independent, impartial review of claims processing procedures and reimbursement methodologies utilized by purchased-care contractors, assesses purchased-care contractor compliance with TRICARE policies and directives, and monitors the claims processing performance of DHA TRICARE purchased-care support contractors. The contractor shall evaluate the accuracy of claims payment and payment record coding for the six purchased-care contractors.
This contract also supports IPEB’s requirement to assess the potential risk of improper payments, identify and report improper payments to the Office of Management and Budget (OMB) for publication in the Department of Defense (DoD), Agency Financial Report (AFR) pursuant to Public Law (PL) 116-117 – Payment Integrity Information Act (PIIA) of 2019.
The anticipated period of performance is a base period/transition-in of six (6) months plus seven (7) 12-month option periods.
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